Diagnostic tools of heart failure with preserved ejection fraction : Comparison of left atrial strain to the HFA-PEFF score

Abstract

Introduction: Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging. Several diagnostic criteria have been proposed, and current guidelines recommend using the HFA-PEFF score in the diagnostic algorithm for HFpEF. We sought to evaluate the clinical utility of left atrial strain (LAS) in the diagnosis of HFpEF as assessed by the HFA-PEFF score. Methods: This was a prospective, mono-centric, cross-sectional study conducted from October 2021 to June 2022 in the Cardiology Department of the Internal Security Forces Hospital of Marsa, Tunisia. Patients were classified into two groups (A and B) based on the HFpEF diagnosis assessed by the HFA-PEFF scoring system: Group A with a score of ≥5 and Group B with a score of <5. Results: A total of 110 patients were eligible for the study. The mean age was 61 ± 11 years. A female predominance was noted, with 57% of the patients being female. Hypertension and diabetes were the most common cardiovascular risk factors, found in 81.8% (n=90) and 54.5% (n=60) of patients, respectively. The median HFA-PEFF score was 4 [2-6]. Forty-six patients (41.6%) were given a clinical diagnosis of HFpEF. LAS analysis showed that PALS (p<0.001) and PACS (p<0.001) were significantly lower in Group A compared with Group B. PALS was strongly correlated with the HFA-PEFF score (r=-0.693, p<0.001). PALS (AUC=0.889; p<0.001) was significantly the best predictor of HFpEF diagnosis. After multivariate analysis, PALS (HR=0.782; 95% CI: 0.629-0.973; p=0.027) was an independent predictor of HFpEF diagnosis, with a cut-off value of 24% (sensitivity of 86% and specificity of 89.5%). Conclusion: PALS is a simple and sensitive ultrasound parameter that can be used for the diagnosis of HFpEF.